|
NALTREXONE ER 380 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE
|
Facility
|
IP
|
$5,030.47
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
76527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,269.81 |
| Max. Negotiated Rate |
$4,527.42 |
| Rate for Payer: Aetna Commercial |
$4,275.90
|
| Rate for Payer: BCBS Trust/PPO |
$4,106.37
|
| Rate for Payer: BCN Commercial |
$3,887.55
|
| Rate for Payer: Cash Price |
$4,024.38
|
| Rate for Payer: Cofinity Commercial |
$4,326.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,024.38
|
| Rate for Payer: Healthscope Commercial |
$4,527.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,772.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,275.90
|
| Rate for Payer: Nomi Health Commercial |
$4,124.99
|
| Rate for Payer: PHP Commercial |
$4,275.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,269.81
|
| Rate for Payer: Priority Health HMO/PPO |
$4,376.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,370.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,426.81
|
| Rate for Payer: UHC Core |
$4,200.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,772.85
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$4.26
|
|
|
Service Code
|
NDC 50268059411
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: BCBS Trust/PPO |
$3.48
|
| Rate for Payer: BCN Commercial |
$3.29
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cofinity Commercial |
$3.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.41
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.62
|
| Rate for Payer: Nomi Health Commercial |
$3.49
|
| Rate for Payer: PHP Commercial |
$3.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.77
|
| Rate for Payer: Priority Health HMO/PPO |
$3.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.75
|
| Rate for Payer: UHC Core |
$3.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.19
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$155.10
|
|
|
Service Code
|
NDC 65162018810
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.81 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: BCBS Trust/PPO |
$126.61
|
| Rate for Payer: BCN Commercial |
$119.86
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Nomi Health Commercial |
$127.18
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.81
|
| Rate for Payer: Priority Health HMO/PPO |
$134.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.49
|
| Rate for Payer: UHC Core |
$129.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.33
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
OP
|
$212.68
|
|
|
Service Code
|
NDC 50268059415
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.51 |
| Max. Negotiated Rate |
$191.41 |
| Rate for Payer: Aetna Commercial |
$180.78
|
| Rate for Payer: Aetna Medicare |
$55.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.46
|
| Rate for Payer: BCBS Complete |
$85.07
|
| Rate for Payer: BCBS MAPPO |
$53.17
|
| Rate for Payer: BCBS Trust/PPO |
$174.84
|
| Rate for Payer: BCN Commercial |
$165.36
|
| Rate for Payer: BCN Medicare Advantage |
$53.17
|
| Rate for Payer: Cash Price |
$170.14
|
| Rate for Payer: Cofinity Commercial |
$182.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.17
|
| Rate for Payer: Healthscope Commercial |
$191.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.78
|
| Rate for Payer: Nomi Health Commercial |
$174.40
|
| Rate for Payer: PACE Senior Care Partners |
$50.51
|
| Rate for Payer: PACE SWMI |
$53.17
|
| Rate for Payer: PHP Commercial |
$180.78
|
| Rate for Payer: PHP Medicare Advantage |
$53.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.24
|
| Rate for Payer: Priority Health HMO/PPO |
$185.03
|
| Rate for Payer: Priority Health Medicare |
$53.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.50
|
| Rate for Payer: Railroad Medicare Medicare |
$53.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.16
|
| Rate for Payer: UHC Core |
$177.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.17
|
| Rate for Payer: UHC Exchange |
$53.17
|
| Rate for Payer: UHC Medicare Advantage |
$53.17
|
| Rate for Payer: VA VA |
$53.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.51
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$212.68
|
|
|
Service Code
|
NDC 50268059415
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.24 |
| Max. Negotiated Rate |
$191.41 |
| Rate for Payer: Aetna Commercial |
$180.78
|
| Rate for Payer: BCBS Trust/PPO |
$173.61
|
| Rate for Payer: BCN Commercial |
$164.36
|
| Rate for Payer: Cash Price |
$170.14
|
| Rate for Payer: Cofinity Commercial |
$182.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.14
|
| Rate for Payer: Healthscope Commercial |
$191.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.78
|
| Rate for Payer: Nomi Health Commercial |
$174.40
|
| Rate for Payer: PHP Commercial |
$180.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.24
|
| Rate for Payer: Priority Health HMO/PPO |
$185.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.16
|
| Rate for Payer: UHC Core |
$177.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.51
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
OP
|
$4.26
|
|
|
Service Code
|
NDC 50268059411
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: Aetna Medicare |
$1.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.33
|
| Rate for Payer: BCBS Complete |
$1.70
|
| Rate for Payer: BCBS MAPPO |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$3.50
|
| Rate for Payer: BCN Commercial |
$3.31
|
| Rate for Payer: BCN Medicare Advantage |
$1.06
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cofinity Commercial |
$3.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.06
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.62
|
| Rate for Payer: Nomi Health Commercial |
$3.49
|
| Rate for Payer: PACE Senior Care Partners |
$1.01
|
| Rate for Payer: PACE SWMI |
$1.06
|
| Rate for Payer: PHP Commercial |
$3.62
|
| Rate for Payer: PHP Medicare Advantage |
$1.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.77
|
| Rate for Payer: Priority Health HMO/PPO |
$3.71
|
| Rate for Payer: Priority Health Medicare |
$1.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.75
|
| Rate for Payer: UHC Core |
$3.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.06
|
| Rate for Payer: UHC Exchange |
$1.06
|
| Rate for Payer: UHC Medicare Advantage |
$1.06
|
| Rate for Payer: VA VA |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.19
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$185.65
|
|
|
Service Code
|
NDC 68462018801
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$167.09 |
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: BCBS Trust/PPO |
$151.55
|
| Rate for Payer: BCN Commercial |
$143.47
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$167.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Nomi Health Commercial |
$152.23
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health HMO/PPO |
$161.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.37
|
| Rate for Payer: UHC Core |
$155.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
OP
|
$155.10
|
|
|
Service Code
|
NDC 65162018810
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.84 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna Medicare |
$40.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.47
|
| Rate for Payer: BCBS Complete |
$62.04
|
| Rate for Payer: BCBS MAPPO |
$38.77
|
| Rate for Payer: BCBS Trust/PPO |
$127.51
|
| Rate for Payer: BCN Commercial |
$120.59
|
| Rate for Payer: BCN Medicare Advantage |
$38.77
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.77
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Nomi Health Commercial |
$127.18
|
| Rate for Payer: PACE Senior Care Partners |
$36.84
|
| Rate for Payer: PACE SWMI |
$38.77
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: PHP Medicare Advantage |
$38.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.81
|
| Rate for Payer: Priority Health HMO/PPO |
$134.94
|
| Rate for Payer: Priority Health Medicare |
$39.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.92
|
| Rate for Payer: Railroad Medicare Medicare |
$38.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.49
|
| Rate for Payer: UHC Core |
$129.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.77
|
| Rate for Payer: UHC Exchange |
$38.77
|
| Rate for Payer: UHC Medicare Advantage |
$38.77
|
| Rate for Payer: VA VA |
$38.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.33
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
OP
|
$185.65
|
|
|
Service Code
|
NDC 68462018801
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$167.09 |
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna Medicare |
$48.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.02
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: BCBS MAPPO |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$152.62
|
| Rate for Payer: BCN Commercial |
$144.34
|
| Rate for Payer: BCN Medicare Advantage |
$46.41
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.41
|
| Rate for Payer: Healthscope Commercial |
$167.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Nomi Health Commercial |
$152.23
|
| Rate for Payer: PACE Senior Care Partners |
$44.09
|
| Rate for Payer: PACE SWMI |
$46.41
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: PHP Medicare Advantage |
$46.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health HMO/PPO |
$161.52
|
| Rate for Payer: Priority Health Medicare |
$46.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.39
|
| Rate for Payer: Railroad Medicare Medicare |
$46.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.37
|
| Rate for Payer: UHC Core |
$155.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.41
|
| Rate for Payer: UHC Exchange |
$46.41
|
| Rate for Payer: UHC Medicare Advantage |
$46.41
|
| Rate for Payer: VA VA |
$46.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
NAPROXEN 500 MG TABLET
|
Facility
|
OP
|
$420.65
|
|
|
Service Code
|
NDC 63739040310
|
| Hospital Charge Code |
5393
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.90 |
| Max. Negotiated Rate |
$378.58 |
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: Aetna Medicare |
$109.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.45
|
| Rate for Payer: BCBS Complete |
$168.26
|
| Rate for Payer: BCBS MAPPO |
$105.16
|
| Rate for Payer: BCBS Trust/PPO |
$345.82
|
| Rate for Payer: BCN Commercial |
$327.06
|
| Rate for Payer: BCN Medicare Advantage |
$105.16
|
| Rate for Payer: Cash Price |
$336.52
|
| Rate for Payer: Cofinity Commercial |
$361.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.16
|
| Rate for Payer: Healthscope Commercial |
$378.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.55
|
| Rate for Payer: Nomi Health Commercial |
$344.93
|
| Rate for Payer: PACE Senior Care Partners |
$99.90
|
| Rate for Payer: PACE SWMI |
$105.16
|
| Rate for Payer: PHP Commercial |
$357.55
|
| Rate for Payer: PHP Medicare Advantage |
$105.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.42
|
| Rate for Payer: Priority Health HMO/PPO |
$365.97
|
| Rate for Payer: Priority Health Medicare |
$106.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.84
|
| Rate for Payer: Railroad Medicare Medicare |
$105.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.17
|
| Rate for Payer: UHC Core |
$351.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.16
|
| Rate for Payer: UHC Exchange |
$105.16
|
| Rate for Payer: UHC Medicare Advantage |
$105.16
|
| Rate for Payer: VA VA |
$105.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.49
|
|
|
NAPROXEN 500 MG TABLET
|
Facility
|
IP
|
$420.65
|
|
|
Service Code
|
NDC 63739040310
|
| Hospital Charge Code |
5393
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.42 |
| Max. Negotiated Rate |
$378.58 |
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: BCBS Trust/PPO |
$343.38
|
| Rate for Payer: BCN Commercial |
$325.08
|
| Rate for Payer: Cash Price |
$336.52
|
| Rate for Payer: Cofinity Commercial |
$361.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.52
|
| Rate for Payer: Healthscope Commercial |
$378.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.55
|
| Rate for Payer: Nomi Health Commercial |
$344.93
|
| Rate for Payer: PHP Commercial |
$357.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.42
|
| Rate for Payer: Priority Health HMO/PPO |
$365.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.17
|
| Rate for Payer: UHC Core |
$351.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.49
|
|
|
NASAL MUCOSAL ATOMIZATION DEVICE
|
Facility
|
IP
|
$3.19
|
|
|
Service Code
|
NDC 09900000401
|
| Hospital Charge Code |
169209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.60
|
| Rate for Payer: BCN Commercial |
$2.47
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.55
|
| Rate for Payer: Healthscope Commercial |
$2.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.71
|
| Rate for Payer: Nomi Health Commercial |
$2.62
|
| Rate for Payer: PHP Commercial |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.07
|
| Rate for Payer: Priority Health HMO/PPO |
$2.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.81
|
| Rate for Payer: UHC Core |
$2.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.39
|
|
|
NASAL MUCOSAL ATOMIZATION DEVICE
|
Facility
|
OP
|
$3.19
|
|
|
Service Code
|
NDC 09900000401
|
| Hospital Charge Code |
169209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.71
|
| Rate for Payer: Aetna Medicare |
$0.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.00
|
| Rate for Payer: BCBS Complete |
$1.28
|
| Rate for Payer: BCBS MAPPO |
$0.80
|
| Rate for Payer: BCBS Trust/PPO |
$2.62
|
| Rate for Payer: BCN Commercial |
$2.48
|
| Rate for Payer: BCN Medicare Advantage |
$0.80
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.80
|
| Rate for Payer: Healthscope Commercial |
$2.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.71
|
| Rate for Payer: Nomi Health Commercial |
$2.62
|
| Rate for Payer: PACE Senior Care Partners |
$0.76
|
| Rate for Payer: PACE SWMI |
$0.80
|
| Rate for Payer: PHP Commercial |
$2.71
|
| Rate for Payer: PHP Medicare Advantage |
$0.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.07
|
| Rate for Payer: Priority Health HMO/PPO |
$2.78
|
| Rate for Payer: Priority Health Medicare |
$0.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.14
|
| Rate for Payer: Railroad Medicare Medicare |
$0.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.81
|
| Rate for Payer: UHC Core |
$2.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.80
|
| Rate for Payer: UHC Exchange |
$0.80
|
| Rate for Payer: UHC Medicare Advantage |
$0.80
|
| Rate for Payer: VA VA |
$0.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.39
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS
|
Facility
|
IP
|
$166.15
|
|
|
Service Code
|
NDC 24208079062
|
| Hospital Charge Code |
5474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$149.53 |
| Rate for Payer: Aetna Commercial |
$141.23
|
| Rate for Payer: BCBS Trust/PPO |
$135.63
|
| Rate for Payer: BCN Commercial |
$128.40
|
| Rate for Payer: Cash Price |
$132.92
|
| Rate for Payer: Cofinity Commercial |
$142.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.92
|
| Rate for Payer: Healthscope Commercial |
$149.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.23
|
| Rate for Payer: Nomi Health Commercial |
$136.24
|
| Rate for Payer: PHP Commercial |
$141.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.00
|
| Rate for Payer: Priority Health HMO/PPO |
$144.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.21
|
| Rate for Payer: UHC Core |
$138.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.61
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS
|
Facility
|
OP
|
$166.15
|
|
|
Service Code
|
NDC 24208079062
|
| Hospital Charge Code |
5474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$149.53 |
| Rate for Payer: Aetna Commercial |
$141.23
|
| Rate for Payer: Aetna Medicare |
$43.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.92
|
| Rate for Payer: BCBS Complete |
$66.46
|
| Rate for Payer: BCBS MAPPO |
$41.54
|
| Rate for Payer: BCBS Trust/PPO |
$136.59
|
| Rate for Payer: BCN Commercial |
$129.18
|
| Rate for Payer: BCN Medicare Advantage |
$41.54
|
| Rate for Payer: Cash Price |
$132.92
|
| Rate for Payer: Cofinity Commercial |
$142.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.54
|
| Rate for Payer: Healthscope Commercial |
$149.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.23
|
| Rate for Payer: Nomi Health Commercial |
$136.24
|
| Rate for Payer: PACE Senior Care Partners |
$39.46
|
| Rate for Payer: PACE SWMI |
$41.54
|
| Rate for Payer: PHP Commercial |
$141.23
|
| Rate for Payer: PHP Medicare Advantage |
$41.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.00
|
| Rate for Payer: Priority Health HMO/PPO |
$144.55
|
| Rate for Payer: Priority Health Medicare |
$41.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.32
|
| Rate for Payer: Railroad Medicare Medicare |
$41.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.21
|
| Rate for Payer: UHC Core |
$138.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.54
|
| Rate for Payer: UHC Exchange |
$41.54
|
| Rate for Payer: UHC Medicare Advantage |
$41.54
|
| Rate for Payer: VA VA |
$41.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.61
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$58.60
|
|
|
Service Code
|
NDC 61314063136
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.09 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna Commercial |
$49.81
|
| Rate for Payer: BCBS Trust/PPO |
$47.84
|
| Rate for Payer: BCN Commercial |
$45.29
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.88
|
| Rate for Payer: Healthscope Commercial |
$52.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.81
|
| Rate for Payer: Nomi Health Commercial |
$48.05
|
| Rate for Payer: PHP Commercial |
$49.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.09
|
| Rate for Payer: Priority Health HMO/PPO |
$50.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.57
|
| Rate for Payer: UHC Core |
$48.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.95
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
OP
|
$58.60
|
|
|
Service Code
|
NDC 61314063136
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna Commercial |
$49.81
|
| Rate for Payer: Aetna Medicare |
$15.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.31
|
| Rate for Payer: BCBS Complete |
$23.44
|
| Rate for Payer: BCBS MAPPO |
$14.65
|
| Rate for Payer: BCBS Trust/PPO |
$48.18
|
| Rate for Payer: BCN Commercial |
$45.56
|
| Rate for Payer: BCN Medicare Advantage |
$14.65
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.65
|
| Rate for Payer: Healthscope Commercial |
$52.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.81
|
| Rate for Payer: Nomi Health Commercial |
$48.05
|
| Rate for Payer: PACE Senior Care Partners |
$13.92
|
| Rate for Payer: PACE SWMI |
$14.65
|
| Rate for Payer: PHP Commercial |
$49.81
|
| Rate for Payer: PHP Medicare Advantage |
$14.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.09
|
| Rate for Payer: Priority Health HMO/PPO |
$50.98
|
| Rate for Payer: Priority Health Medicare |
$14.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.26
|
| Rate for Payer: Railroad Medicare Medicare |
$14.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.57
|
| Rate for Payer: UHC Core |
$48.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.65
|
| Rate for Payer: UHC Exchange |
$14.65
|
| Rate for Payer: UHC Medicare Advantage |
$14.65
|
| Rate for Payer: VA VA |
$14.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.95
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$9.83
|
|
|
Service Code
|
NDC 45802014303
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Aetna Commercial |
$8.36
|
| Rate for Payer: BCBS Trust/PPO |
$8.02
|
| Rate for Payer: BCN Commercial |
$7.60
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Cofinity Commercial |
$8.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.86
|
| Rate for Payer: Healthscope Commercial |
$8.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.36
|
| Rate for Payer: Nomi Health Commercial |
$8.06
|
| Rate for Payer: PHP Commercial |
$8.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.39
|
| Rate for Payer: Priority Health HMO/PPO |
$8.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.65
|
| Rate for Payer: UHC Core |
$8.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.37
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$10.13
|
|
|
Service Code
|
NDC 00713026831
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Aetna Commercial |
$8.61
|
| Rate for Payer: BCBS Trust/PPO |
$8.27
|
| Rate for Payer: BCN Commercial |
$7.83
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cofinity Commercial |
$8.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.10
|
| Rate for Payer: Healthscope Commercial |
$9.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.61
|
| Rate for Payer: Nomi Health Commercial |
$8.31
|
| Rate for Payer: PHP Commercial |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.58
|
| Rate for Payer: Priority Health HMO/PPO |
$8.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.91
|
| Rate for Payer: UHC Core |
$8.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.60
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
OP
|
$10.26
|
|
|
Service Code
|
NDC 00904073431
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$9.23 |
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Aetna Medicare |
$2.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.21
|
| Rate for Payer: BCBS Complete |
$4.10
|
| Rate for Payer: BCBS MAPPO |
$2.56
|
| Rate for Payer: BCBS Trust/PPO |
$8.43
|
| Rate for Payer: BCN Commercial |
$7.98
|
| Rate for Payer: BCN Medicare Advantage |
$2.56
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.56
|
| Rate for Payer: Healthscope Commercial |
$9.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.72
|
| Rate for Payer: Nomi Health Commercial |
$8.41
|
| Rate for Payer: PACE Senior Care Partners |
$2.44
|
| Rate for Payer: PACE SWMI |
$2.56
|
| Rate for Payer: PHP Commercial |
$8.72
|
| Rate for Payer: PHP Medicare Advantage |
$2.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.67
|
| Rate for Payer: Priority Health HMO/PPO |
$8.93
|
| Rate for Payer: Priority Health Medicare |
$2.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.87
|
| Rate for Payer: Railroad Medicare Medicare |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.03
|
| Rate for Payer: UHC Core |
$8.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.56
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UHC Medicare Advantage |
$2.56
|
| Rate for Payer: VA VA |
$2.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$10.26
|
|
|
Service Code
|
NDC 00904073431
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$9.23 |
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: BCBS Trust/PPO |
$8.38
|
| Rate for Payer: BCN Commercial |
$7.93
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Healthscope Commercial |
$9.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.72
|
| Rate for Payer: Nomi Health Commercial |
$8.41
|
| Rate for Payer: PHP Commercial |
$8.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.67
|
| Rate for Payer: Priority Health HMO/PPO |
$8.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.03
|
| Rate for Payer: UHC Core |
$8.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
OP
|
$10.13
|
|
|
Service Code
|
NDC 00713026831
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Aetna Commercial |
$8.61
|
| Rate for Payer: Aetna Medicare |
$2.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.17
|
| Rate for Payer: BCBS Complete |
$4.05
|
| Rate for Payer: BCBS MAPPO |
$2.53
|
| Rate for Payer: BCBS Trust/PPO |
$8.33
|
| Rate for Payer: BCN Commercial |
$7.88
|
| Rate for Payer: BCN Medicare Advantage |
$2.53
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cofinity Commercial |
$8.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.53
|
| Rate for Payer: Healthscope Commercial |
$9.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.61
|
| Rate for Payer: Nomi Health Commercial |
$8.31
|
| Rate for Payer: PACE Senior Care Partners |
$2.41
|
| Rate for Payer: PACE SWMI |
$2.53
|
| Rate for Payer: PHP Commercial |
$8.61
|
| Rate for Payer: PHP Medicare Advantage |
$2.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.58
|
| Rate for Payer: Priority Health HMO/PPO |
$8.81
|
| Rate for Payer: Priority Health Medicare |
$2.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.91
|
| Rate for Payer: UHC Core |
$8.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.53
|
| Rate for Payer: UHC Exchange |
$2.53
|
| Rate for Payer: UHC Medicare Advantage |
$2.53
|
| Rate for Payer: VA VA |
$2.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.60
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
OP
|
$9.83
|
|
|
Service Code
|
NDC 45802014303
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Aetna Commercial |
$8.36
|
| Rate for Payer: Aetna Medicare |
$2.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.07
|
| Rate for Payer: BCBS Complete |
$3.93
|
| Rate for Payer: BCBS MAPPO |
$2.46
|
| Rate for Payer: BCBS Trust/PPO |
$8.08
|
| Rate for Payer: BCN Commercial |
$7.64
|
| Rate for Payer: BCN Medicare Advantage |
$2.46
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Cofinity Commercial |
$8.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$8.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.36
|
| Rate for Payer: Nomi Health Commercial |
$8.06
|
| Rate for Payer: PACE Senior Care Partners |
$2.33
|
| Rate for Payer: PACE SWMI |
$2.46
|
| Rate for Payer: PHP Commercial |
$8.36
|
| Rate for Payer: PHP Medicare Advantage |
$2.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.39
|
| Rate for Payer: Priority Health HMO/PPO |
$8.55
|
| Rate for Payer: Priority Health Medicare |
$2.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.59
|
| Rate for Payer: Railroad Medicare Medicare |
$2.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.65
|
| Rate for Payer: UHC Core |
$8.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.46
|
| Rate for Payer: UHC Exchange |
$2.46
|
| Rate for Payer: UHC Medicare Advantage |
$2.46
|
| Rate for Payer: VA VA |
$2.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.37
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
IP
|
$2.94
|
|
|
Service Code
|
NDC 45802014370
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: BCBS Trust/PPO |
$2.40
|
| Rate for Payer: BCN Commercial |
$2.27
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cofinity Commercial |
$2.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.35
|
| Rate for Payer: Healthscope Commercial |
$2.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.50
|
| Rate for Payer: Nomi Health Commercial |
$2.41
|
| Rate for Payer: PHP Commercial |
$2.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.91
|
| Rate for Payer: Priority Health HMO/PPO |
$2.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.59
|
| Rate for Payer: UHC Core |
$2.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.21
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT
|
Facility
|
OP
|
$2.94
|
|
|
Service Code
|
NDC 45802014370
|
| Hospital Charge Code |
116684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: Aetna Medicare |
$0.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.92
|
| Rate for Payer: BCBS Complete |
$1.18
|
| Rate for Payer: BCBS MAPPO |
$0.74
|
| Rate for Payer: BCBS Trust/PPO |
$2.42
|
| Rate for Payer: BCN Commercial |
$2.29
|
| Rate for Payer: BCN Medicare Advantage |
$0.74
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cofinity Commercial |
$2.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.74
|
| Rate for Payer: Healthscope Commercial |
$2.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.50
|
| Rate for Payer: Nomi Health Commercial |
$2.41
|
| Rate for Payer: PACE Senior Care Partners |
$0.70
|
| Rate for Payer: PACE SWMI |
$0.74
|
| Rate for Payer: PHP Commercial |
$2.50
|
| Rate for Payer: PHP Medicare Advantage |
$0.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.91
|
| Rate for Payer: Priority Health HMO/PPO |
$2.56
|
| Rate for Payer: Priority Health Medicare |
$0.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.97
|
| Rate for Payer: Railroad Medicare Medicare |
$0.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.59
|
| Rate for Payer: UHC Core |
$2.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.74
|
| Rate for Payer: UHC Exchange |
$0.74
|
| Rate for Payer: UHC Medicare Advantage |
$0.74
|
| Rate for Payer: VA VA |
$0.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.21
|
|
